Licensed Practical Nurse

Work at Home

Job Description


  • Reviews all health plan denials for eligibility, expiration date, accuracy and completeness
  • Writes all member information in AHCCCS/SNP approved NOA/NOMNC templates to meet regulatory requirements
  • Enters all denials/partial denials/service reductions into the computer systems
  • Performs other related duties, consistent with the goals and qualifications of this position
  • Works cooperatively with both internal and external customers in assisting members and providers with referral related issues
  • Call rotation for the health plan, as well as departmental call rotation for holidays
  • Meets internal and external customer service expectations regarding duties and professionalism
  • This position performs all related duties in a manner that is consistent with and in support of the organization's mission, vision, values and goals
  • This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service

Basic Qualifications

  • Current, unrestricted AZ LPN license permitting work in the State of Arizona
  • A minimum of three years’ experience in an acute care setting
  • At least two years of experience in prior authorization or utilization management, knowledge of insurance, managed care principles, and community facilities and resources
  • Proficient on a computer (PC) with Microsoft Office Products. Ability to work with databases/programs, such as IDX and ability to work independently, with analytical, problem solving, decision making, concurrent and retrospective data management skills are necessary
  • Working knowledge of medical terminology and coding (ICD-9, CPT-4) is required

Preferred Qualifications

  • Case Management experience preferred
  • Experience specific to ICU/Med. Surg. and knowledge of Arizona Health Care Cost Containment System (AHCCCS) and Centers for Medicare and Medicaid Services (CMS) regulations preferred
  • Knowledge of AHCCCS, CMS and regulatory requirements and working knowledge of clinical criteria such as Milliman Care Guidelines is preferred